| NPI | 1578022570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022026343) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.179853) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-05-07 |